Colorectal cancer screening (CRCS) decreases colorectal cancer (CRC) morbidity and mortality, yet remains underutilized. Systems of Support to Increase Colorectal Cancer Screening and Follow-up (SOS) is a 2-year randomized controlled trial designed to increase: (1) CRC screening and (2) follow-up of positive screening tests. The Chronic Care Model and the Preventive Health Model inform study design. For this Competitive Revision we propose two new ancillary aims to address the following questions: 1) Does the medical home model modify (i.e. enhance or reduce) the effectiveness of the SOS intervention? Primary Aim #1: To compare SOS systems-level intervention effect in clinics before and after MH implementation. We hypothesize that SOS systems-level CRCS rates will continue be higher than UC (MH alone) in year 2, but CRCS rates will be modified (lessoned or enhanced) by characteristics of clinics and their implementation of MH components. To test this hypothesis we will collect data on covariates related to process measures related to implementation of the MH and clinic characteristics. 7 Primary outcomes will include to what degree CRCS and FOBT rates are modified by MH implementation and clinic factors. 2) Is a continued systems-level intervention required to maintain increases in CRCS for those choosing annual FOBT? Primary Aim #2: To determine the durability and long-term impact of SOS systems-level automated interventions over time. We hypothesize that continued SOS automated interventions are needed for patients to remain current for FOBT screening over time. We also hypothesize that individuals who have previously completed in years 1-2, will still be more likely to complete CRCS, than those not receiving SOS automated interventions. To test these hypotheses we propose in year 3 to randomize patients in the active intervention groups (auto, assist, and care managed) who are still eligible for CRCS (have not had a colonoscopy or flexible sigmoidoscopy) to either: A. Stopped Auto or B. Continued Auto systems-level FOBT interventions 7 Primary outcomes include CRCS and FOBT rates, categorically (yes/no) in year 3 and as person-time assessments of appropriate CRCS and FOBT coverage in years 1-3 This study will efficiently address these questions by taking advantage of an existing study cohort. PUBLIC HEALTH RELEVANCE: Screening people age 50 to 75 prevents colon cancer from starting and dying from it, but almost half have not been screened. This study is testing how much help patients need to get colon cancer screening done. In the second year of the study, the health plan made changes to how clinics deliver health care. This change is called the "Medical Home" and doctors are given more time to see patients and medical assistants check to see if patients are due for screening tests, such as colon cancer screening, and help at visits or mail letters. We will study whether "Medical Home" care increases colon cancer screening. A second aim of this study will to be to find out if people who choose to do stool cards at home, need to receive these in the mail every year to stay current for screening.